Niu Shuang, Molberg Kyle, Thibodeaux Joel, Rivera-Colon Glorimar, Hinson Stacy, Zheng Wenxin, Lucas Elena
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
J Am Soc Cytopathol. 2019 May-Jun;8(3):141-148. doi: 10.1016/j.jasc.2018.12.004. Epub 2018 Dec 31.
Recognition of adenocarcinoma in situ (AIS) in cervical cytology is challenging.
We calculated the sensitivity and accuracy of Papanicolaou (Pap) tests obtained within 1 year of a histologic diagnosis of AIS from 2007 to 2016. We also correlated it with the coexistence of squamous lesions, calculated the interobserver agreement, and compared these measures with those of endocervical adenocarcinoma (ECCA). We correlated AIS detection with high-risk human papillomavirus (hrHPV) status.
Of 72 patients with histologic AIS and 48 patients with ECCA, 92% and 87.5%, respectively, had abnormal Pap test results. A glandular abnormality was detected in 44.4% of the AIS and 77.1% of the ECCA cases. Complete cytohistologic concordance was reached in 8.3% of AIS and 22.9% of ECCA cases. In addition, 27.8% of AIS and 6.3% of ECCA cases were diagnosed on Pap as a high-risk squamous abnormality. Concurrent squamous lesions were present in 79.2% of patients with AIS and 29.2% of patients with ECCA. The Paps from the AIS and ECCA cases were diagnosed as pure squamous abnormalities in 47.2% and 10.4% of cases, respectively. In the AIS cases, interobserver agreement was substantial for detection of any high-risk cytologic abnormality (kappa = 0.67) and fair for detection of any glandular abnormality (kappa = 0.34). Among the 26 patients with AIS tested for hrHPV, 92% had positive results and 8% had negative results.
The cytologic sensitivity for the detection of AIS remains low. It is directly related to the coexistence of squamous lesions. Cytology and hrHPV as stand-alone screening tests fail in the early detection of a small proportion of glandular lesions, although combined testing will improve their detection rates.
在宫颈细胞学检查中识别原位腺癌（AIS）具有挑战性。
我们计算了2007年至2016年组织学诊断为AIS后1年内获得的巴氏（Pap）试验的敏感性和准确性。我们还将其与鳞状病变的共存情况相关联，计算了观察者间的一致性，并将这些指标与宫颈管腺癌（ECCA）的指标进行了比较。我们将AIS检测与高危型人乳头瘤病毒（hrHPV）状态相关联。
在72例组织学诊断为AIS的患者和48例ECCA患者中，分别有92%和87.5%的巴氏试验结果异常。在44.4%的AIS病例和77.1%的ECCA病例中检测到腺性异常。8.3%的AIS病例和22.9%的ECCA病例实现了细胞组织学完全一致。此外，27.8%的AIS病例和6.3%的ECCA病例在巴氏检查中被诊断为高危鳞状异常。79.2%的AIS患者和29.2%的ECCA患者同时存在鳞状病变。AIS和ECCA病例的巴氏涂片分别有47.2%和10.4%被诊断为单纯鳞状异常。在AIS病例中，观察者间在检测任何高危细胞学异常方面的一致性较高（kappa = 0.67），在检测任何腺性异常方面的一致性一般（kappa = 0.34）。在26例检测hrHPV的AIS患者中，92%结果为阳性，8%结果为阴性。
检测AIS的细胞学敏感性仍然较低。它与鳞状病变的共存直接相关。细胞学检查和hrHPV作为单独的筛查试验无法早期检测出一小部分腺性病变，尽管联合检测将提高它们的检出率。
